Is the Oral Chemical Prophylaxis Necessary for the Prevention of Venous Thromboembolism after Joint Arthroplasty in a Korean Population?

Abstract

Purpose Venous thromboembolism (VTE) is a serious complication that may occur after a major orthopedic surgery. The aim of the present study was to determine the necessity of a chemical thromboprophylactic agent (rivaroxaban [RXB]) by analyzing the prevalence of VTE in Korean arthroplasty patients who received RXB for prophylaxis compared with those who did not receive RXB. Materials and Methods A total of 2,603 patients who underwent knee or hip arthroplasty between 1996 and 2017 were prospectively evaluated. Of these, 1,608 patients underwent surgery before January 2010 and were not administered any type of prophylaxis after surgery; the remaining 995 underwent surgery after 2010 and received oral RXB once daily for 5–13 days from the day after hemovac drain removal to postoperative day 14. Results The primary study outcome was the prevalence of VTE, pulmonary embolism or death during follow up. The overall incidence of VTE was 1.69% (n=44); of these, 12 occurred in the RXB group and 32 in the non-prophylactic group. The odds ratio of VTE in the RXB group was 0.61. However, the statistical power of the study was 0.313 due to the low incidence of VTE. Conclusion Treatment with oral chemical prophylaxis decreased the incidence of VTE after knee or hip arthroplasty in a Korean population. Furthermore, no serious complications occurred after administering oral RXB, which, coupled with its convenience, suggests oral RXB offers an attractive alternative to other agents. However, we recommend that further studies, including a multicenter study, be conducted to achieve adequate statistical power.

The application of thromboelastography in risk stratification for selective thromboembolism prophylaxis after total joint arthroplasty in Chinese: a randomized controlled trial

“…On the other hand, some researchers used an extreme method that did not include any chemoprophylaxis for Asian patients (29,30). The underlying reason is as follows: in high-risk situations in Western countries, the incidence of VTE is generally thought to be low in Asians (3,4,31).…”

Prevalence of Venous Thromboembolism after Immediate Screening in Hip Fracture Patients

“…Although no definitive leading pharmacological agent has been identified, LMWH has become the standard agent according to many guidelines based on increased bioavailability, low bleeding complications, and long plasma half-life 14 , 24 , 25 , 27 ) . Promising results in reduction of VTE have been achieved with aspirin and direct oral anticoagulant such as rivaroxaban, however, there are concerns with regard to hemorrhagic events in the immediate postoperative period 26 , 28 , 29 ) . Regarding treatment of preoperative VTE, there is no definite protocol for treatment of patients with preoperative VTE who require surgery, and inferior vena cava filtering is reserved for patients who cannot receive any form of prophylaxis preoperatively 30 ) .…”

Effectiveness of Deep Venous Thrombosis Prevention in Total Hip Arthroplasty

“…12 When consulting the literature, it is evident that it is not yet defined as to which drug agent actually has superiority in terms of collective efficacy and safety when compared to each other. 13 The use of enoxaparin (ENX), as well as other substances that act in the coagulation cascade, such as ASA, rivaroxaban (RVX), 14,15 Fondaparinux (FPX) or apixaban (APX), have been proven to reduce the incidence of VTE. 13,15,16 However, each of these substances has a series of complications, such as increased risk of massive bleeding.…”

“…( 13 The use of enoxaparin (ENX), as well as other substances that act in the coagulation cascade, such as ASA, rivaroxaban (RVX), ( 14 ), ( 15 Fondaparinux (FPX) or apixaban (APX), have been proven to reduce the incidence of VTE. ( 13 ), ( 15 ), ( 16 However, each of these substances has a series of complications, such as increased risk of massive bleeding. We know that ENX and ASA have similar bleeding risks, both of which had better results when compared with the use of RVX.…”